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Critical Clues Can Saves Millions from Ravages of Facial Disorder

Today’s expanding knowledge of the many potential signs and symptoms of rosacea can help unmask this widespread but poorly understood facial disorder now estimated to affect more than 16 million Americans. “It has been called ‘The Great Imposter’ because people often confuse rosacea with other conditions, such as a sunburn or acne, or even eye irritation, and fail to seek medical help,” said Dr. Jonathan Wilkin, chairman of the National Rosacea Society (NRS) medical advisory board. “People need to be more aware of this highly prevalent disorder, and the need for treatment and lifestyle changes before it becomes progressively severe.”

The incidence of rosacea is now rapidly growing as the populous baby boom generation passes through the most frequent ages of onset – between 30 and 60. Yet, surveys have found that the public has little knowledge of this chronic but treatable disorder, including how to recognize it and what to do about it.

Among the most famous rosacea sufferers is former President Bill Clinton, whose doctors disclosed that he has this condition in The New York Times. Others reported to have suffered from the disorder include comedian W.C. fields, Princess Diana, financier J.P. Morgan, and the Dutch painter Rembrandt.

Characterized by relapse and remissions, rosacea typically begins as a redness or flushing on the cheeks, nose, chin, or forehead that may come and go. Over time, the redness becomes ruddier and more persistent, and visible blood vessels may appear.

This condition, known as subtype 1 rosacea, often occurs before or at the same time as subtype 2 rosacea, which includes facial redness with bumps and pimples if left untreated. In severe cases the skin may become swollen and bumpy, especially around the nose – a condition known as subtype 3 rosacea, or rhinophyma.

In many rosacea sufferers, the eyes are also affected, feeling irritated and appearing watery or bloodshot. Without proper care, this condition, known as subtype 4 or ocular rosacea, can lead to further irritation and, in severe cases, reduction of vision.

In a new survey of 1,289 rosacea patients conducted by the NRS, 71 percent of the respondents said they had experienced persistent redness, and 63 percent said they had suffered from frequent flushing. In addition, 63 percent said they had suffered outbreaks of pimples (pustules) and 61 percent reported experiencing bumps (papules).

Sixty-one percent of the patients said they had also experienced eye symptoms, and visible blood vessels were cited by 56 percent. Other widely reported signs and symptoms included facial burning or stinging, reported by 51 percent; facial itching, experienced by 41 percent; dry appearance, named by 40 percent; raised red patches, reported by 30 percent; skin thickening or excess tissue on the nose, 22 percent; signs beyond the face, 21 percent; and facial swelling, 18 percent.

“Although the subtypes of rosacea represent common patterns, the manifestations of rosacea can vary substantially from one patient to another, and medical therapy must therefore be tailored for each individual case,” Wilkin said. “With greater knowledge of its potential signs and symptoms, physicians should be able to achieve significant improvements in the diagnosis and management of this chronic and often life-disruptive disorder.”

Perhaps even more devastating than its physical effects, rosacea often inflicts significant emotional and social damage on the lives of its victims because of its impact on personal appearance. In recent surveys by the NRS, nearly 76 percent of rosacea patients said this unsightly disorder had lowered their self-confidence and self-esteem, and 41 percent reported it had caused the to avoid public contact or cancel social engagements.

Adding to the embarrassment is a common myth that rosacea sufferers, who often have a red face and nose, are heavy drinkers. In fact, while alcohol may aggravate the disorder, the symptoms can be just as severe in a nondrinker.

Another common misconception is that rosacea is caused by poor hygiene, while in reality it is unrelated to personal cleanliness.

Although the cause of rosacea is unknown, a vast array of lifestyle and environmental factors can trigger flare-ups of signs and symptoms in various rosacea sufferers. Common rosacea triggers include sun exposure, emotional stress, hot or cold weather, wind, heavy exercise, alcohol, spicy foods, heated beverages, humidity, certain skin-care products, and many others.

“The good news is that rosacea can be effectively controlled with medical therapy and lifestyle changes to avoid factors that aggravate the condition in individual cases,” Wilkin said. Individuals with any of the following warning signs of rosacea are urged to see a dermatologist for diagnosis and appropriate care: